Burns are a type of injury to the skin tissues, nerves, muscles and bones as a result of direct transfer of heat by: electricity, radiation, chemicals, light, fire, and friction. The resulting damage to the tissue can be superficial, partial thickness and full thickness.

The best thing that people can do at the onset of a burn is to immediately cool the area with cool running water from a shower, hose, tap or any other method for at least 20 minutes. This doesn’t preclude you from calling an Ambulance while you do this. If you don’t have clean running water, but there is some water available, soak towels or clean linnen into the water and then use this to gently lay on the burns wound.

Assess burns injury

We look for signs of airway involvement (these are all bad signs):

Hoarse voice

Inspiratory stridor

Singed facial and nasal hairs

See-saw breathing

Carbonaceous material around mouth, nose, or in the sputum.

How do we classify burns in Australia?

Burns are divided into three categories. These are,

Superficial (like a bad sunburn)

Partial thickness (mild blistering)

Full thickness (black charring of the skin)

We then assess the burns area to determine a percentage of the skin affected. Their are multiple different techniques or algorithms for working this out. In Australia, I believe most Ambulance Services work on the Rule of Nines.

Assessing Body Surface Area

Rule of Nines

In this system, we divide the rule up into Adult patients and Paediatric patients (ultimately, its is only a guide of how much the body has been burned for fluid resusciation purposes).

For an Adult

We attribute:

9% for head

18% front torso

18% back torso

9% each arm

18% each leg

1% for the groin

For Paediatrics

18% for head

18% front torso

18% back torso

14% each leg

9% each arm

Palm and fingers of patient

You can also use the size of the patient’s palm and fingers relates to 1% of their total body. You can therefore use this to give a rough estimate of the total surface area of burns.

Burns area care

Remove all jewellery, tigh, burt or wet clothing, and if the burn is in a limb, elevate the limb to reduce swelling.

Fluid replacement formula

Each Ambulance Service has its own formula for calculating fluid replacement post burns.

This is one formula:

Percentage of Burns Surface Area (BSA) x Weight – over 4 hours.

For example, if we have an adult patient who as 15% burns and weighs 70kg, we would calculate,

BSA15 x 70kg =1050 mls of fluid. We then administer this over 4 hours – about 262mls per hour

Assess temperature

These patients are very susceptible to hypothermia due to excessive cooling. You should regularly check the patients emperature and keep them warm.

Burns Pathophysiology –When large parts of the body is burnt this will effect most other sytems of the body. This is why treatment of severe burns, as a paramedic, nurse or doctor requires continuous monitoring of other body systems, and treatment holistically, including replacement of electrolytes, plasma, and fluids.

These are the main body systems which are affected by severe burns.

Skeletal System

Red bone marrow replaces red blood cells which is destroyed by the burnt skin. If the burns area is too large for the bone marrow to compensate for the loss in red blood cells, the patient will require blood transfusions to survive.

Cardiovascular System

Burning of the skin will lead to an increase in capillary permeability, which causes an increase in blood vasculature – this then results in a decrease of blood pressure as well as live blood volume. This further decreases the blood flow and oxygenation to tissues, which then also results in oedema, shock and eventually death.

Muscular System

Anytime the body becomes hypermetabolic (which is does in the case of a burn), one first areas to be targeted is muscle mass.

Nervous System

Pain is primarily only felt in the partial-thickness burns, where as in full thick-ness burns the nerve cells are destroyed and the patient will feel nothing. As a result of the abnormal levels of circulating potasium ions (K+) such as high K+ due to cellular destruction and the efflux (outward flow) of potasium ions causing hyperkalaemia (high potasium) or hypokalaemia (low potasium) as a result of rapid K+ loss as a result of fluid in the burn, the nervous system transmission of messages, may work faster or slower than normal or not at all.

Respiratory System

Airway obstruction caused by gross oedema of the throat. Also, these patients may have an increased respiratory rate as a result of pulmonary oedema (secondary to smoke inhalation) or increased respiratory rate as an attempt to compensate the increased metabolic rate.

Endocrine System

Increased secretions of adrenaline and nor-adrenaline in response to the injury may lead to increased body temperature and increased cell metabolism.

Lymphatic System

Inflammation increases as a result of damaged tissue, which results in greater strain on the lymphatic system and pitting oedema.

Immune System

Decreased response as a result of excessive strain on the lymphatic system and due to increased infection as a result of burns area removing the first line of infection defence.

Digestive

Due to the potential hypovolaemic state in which a body with severe burns is likely to be in, their is a decrease in blood availability in the intestinal lining and liver. The intestinal lining automatically increases nutrients required to support metabolsim and repair of damaged cells.

Urinary

The kidneys compensate for the increased fluid loss as a result of the burn area by decreasing urine output. The potential detriment of this change is the potential for kidney damage as a result of poor perfusion.